Nephrotic Syndrome

What is nephrotic syndrome?

Nephrotic syndrome causes scarring or damage to the filtering part of the kidneys
(glomeruli). This causes too much protein to be lost from the blood into the urine.

People with nephrotic syndrome often have:

Very high levels of protein in the urine (proteinuria)

Low levels of protein in the blood (hypoalbuminemia)

Swelling (edema), especially around the eyes, feet, and hands

High cholesterol

What causes nephrotic syndrome?

Nephrotic syndrome results from damage to the kidneys' glomeruli. These are the tiny
blood vessels that filter waste and excess water from the blood and send them to the
bladder as urine.

Your glomeruli keep protein in the body. When they are damaged, protein leaks into
the urine. Healthy kidneys allow less than 1 gram of protein to spill into the urine
in a day. In nephrotic syndrome, the glomeruli let 3 grams or more of protein to leak
into the urine during a 24-hour period.

Nephrotic syndrome may happen with other health problems, such as kidney disease caused
by diabetes and immune disorders. It can also develop after damage from viral infections.

The cause of nephrotic syndrome is not always known.

What are the symptoms of nephrotic syndrome?

Nephrotic syndrome is a set of symptoms. These are the most common:

High blood pressure

Swelling in the feet and hands, and around the eyes

Weight gain with fluid retention and swelling

Signs of infection such as fever, or an elevated white blood cell count

Swelling and pain related to blood clots as the blood becomes thickened

Urine that appears foamy from protein loss from the body into voided urine

The symptoms of nephrotic syndrome may look like other medical conditions or problems.
Always talk with your healthcare provider for a diagnosis.

How is nephrotic syndrome diagnosed?

Your healthcare provider will review medical history and do a physical exam. Other
tests may include:

Blood pressure checks

Measurement of your cholesterol levels

Measurement of protein levels in your urine and in the blood

Kidney biopsy (exam of a sample of kidney tissue)

What is the treatment for nephrotic syndrome?

Your healthcare provider will figure out the best treatment based on:

How old you are

Your overall health and medical history

How sick you are

How well you can handle specific medicines, procedures, or therapies

How long the condition is expected to last

Your opinion or preference

Your healthcare provider will try to find the underlying cause. He or she will also
attempt to control blood pressure and cholesterol, and reduce protein in the urine.

Medicines can include:

ACE inhibitors and angiotensin receptor blockers (ARBs). These lower blood pressure and may be used
in people with diabetes to protect the kidneys.

Corticosteroids. These may be prescribed to reduce swelling and inflammation within the glomerulus.
They also help prevent your immune system from attacking healthy tissue.

Diuretics. These are cautiously used to decrease the amount of swelling.

Immune system modifying medicines. These medicines are used to keep your immune system from attacking the glomerulus.

Cholesterol-lowering medicines. These may be prescribed if your triglyceride and cholesterol levels are high.

Anticoagulants. These are blood thinning medicines and may be prescribed if blood clots develop.

Antibiotics or antiviral medicines. These are used to treat the underlying infectious cause.

Diet. A special diet can help delay the need for dialysis and to get rid of extra fluid
and toxins that build up. Avoid salt to prevent more swelling. Avoid fats and cholesterol.
Be sure to eat lean protein.

Dialysis is used in extreme cases to remove fluid and toxins when your kidneys have severely
impaired filtering.

What are the complications of nephrotic syndrome?

Serious complications of nephrotic syndrome include kidney failure or end stage renal
disease (ESRD). This requires short-term or long-term dialysis. Blood clots and infection
are other complications. These happen due to the loss of protein in the urine (proteinuria).

Can nephrotic syndrome be prevented?

Not all causes of nephrotic syndrome can be prevented. To prevent damage to the glomeruli:

Make sure your blood pressure is well controlled.

If you have diabetes, make sure your blood sugar is controlled.

Keep up-to-date with vaccines that help to prevent common infections. This is especially
true if you work or live around people who have hepatitis and other viral infections.

Finish all antibiotics as prescribed. Do not stop your antibiotics because you may
be feeling better. And, don’t save them for a later date.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider
know.

Key points about nephrotic syndrome

Nephrotic syndrome develops when there is damage to the filtering part of the kidneys
(glomerulus). This results in protein spilling into the urine (proteinuria).

Loss of the proteins from your blood allows fluid to leak out of the blood vessels
into the nearby tissues causing swelling.

The blood within your blood vessels will become thick with the loss of fluid into
the tissue. This increases the risk for a blood clot.

Your body will try to replace the lost proteins by increased production through the
liver. This can result in high cholesterol.

You will need to avoid excess sodium and fluid intake to prevent worsening fluid buildup
in the tissue.

Medicines are used to treat the underlying cause or help your body get rid of excess
fluid.

Dialysis may be needed if kidney failure develops which can happen in extreme cases.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells
you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.

Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.

Ask if your condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if you do not take the medicine or have the test or procedure.

If you have a follow-up appointment, write down the date, time, and purpose for that
visit.